Health Psychology

1. Health Psychology Lecture 3 Stress and Stress Management

2. Lecture 3 - Outline • Part 1 • What is stress? • What causes stress? • How do we measure stress? • Part 2 • What are the effects of stress on mental/physical health? • Moderating variables • Stress management • Part 3 • Anna Nagy (stress researcher)

3. Question What is stress?

4. Question What is stress? … Any circumstances that threaten or are perceived to threaten one’s well-being and that thereby tax one’s coping abilities.

5. Question What is stress? … Any circumstances that threaten or are perceived to threaten one’s well-being and that thereby tax one’s coping abilities (?) A state of heightened mental and physical arousal in response to a demand (?) Perceived inability to adjust to, meet demands (?)

6. … the text book definition What is stress? … “The condition in which person-environment transactions lead to a perceived discrepancy between the physical and psychological demands of a situation and the resources of the individual’s biological, psychological, or social systems” (Sarafino, p. 71)

7. What is Stress? Stress as an eventStress as a response Controllability Physiological Predictability Emotional Psychological Behavioral

8. Physiological features Sympathetic Nervous System • Arouses the body for action in the event of a threat • “fight or flight” •  heart rate,  blood pressure,  blood to heart and voluntary muscles, dilates airways Hormones • SNS stimulates release of adrenalin and noradrenalin • Similar effects to SNS but more enduring • Corticosteroids (cortisol) -  blood glucose,  immune system activity.

10. Emotional features Fear and anxiety • Uneasiness and apprehension • Strain and tension • E.g., waiting for surgery, exam result Depression • Sad, blue, unhappy (not clinical = severe, long lasting) Anger • Particularly when the situation is harmful or frustrating

11. Performance Arousal Cognitive features Attention and Memory • Stress occupies attention and other cognitive resources • Impaired encoding and retrieval of information (learning)? Perception of events Performance • Yerkes-Dodson Law

12. Performance Arousal Cognitive features Attention and Memory • Stress occupies attention and other cognitive resources • Impaired encoding and retrieval of information (learning)? Concentration Performance • Yerkes-Dodson Law Memory for Stressful Events (p. 78) Stress can enhance our attention toward the stressor. Experiment: participants see pictures of a boy going to hospital.. Some hear an emotional story (terrible accident) others hear neutral (going to watch activities) Before the story, participants received an injection (placebo or drug that inhibits adrenalin). One week later, participants with the placebo (more aroused) remembered more of the story than participants who received the drug (less aroused) No difference for recall of neutral story Adrenalin enhances the memory of stressors we experience

13. Behavioral features Changes in health-related behaviors • Sleep • Diet • Drugs • Social behavior (can help each other, or  hostile/insensitive) •  risk taking •  health care (don’t notice symptoms) Coping • Any attempt to deal with the stressor or stress response • May be adaptive or maladaptive

14. What is Stress? Intervening Factors Stress Reactions Stressor • Appraisal • Perceived Control / • Predictability • Personality • Social Support • Coping Skills

15. PRIMARY APPRAISAL +ve, -ve, or neutral. Degree of threat. POTENTIAL STRESSOR STRESS RESPONSE SECONDARY APPRAISAL Resources / abilities Can I cope? What is Stress? Lazarus (1968)

16. Stress Appraisal Model The “stress process”

17. Stress Appraisal Model Stress and the appraisal process

18. What is Stress? Stress as a Process • The process by which we appraise and cope with environmental threats and challenges Sources of Threat and Challenge • Frustration (unable to reach a desired goal) • Conflict (decision making, e.g., approach-avoidance) • Change (adapting to new circumstances) • Pressure (expectations to behave in a certain way)

19. Vicarious Stress? Does the threat need to relate to us directly to elicit stress? Subincision (Lazarus et al., 1964) • Film of young boys from a primitive culture “in which the underside of the penis is cut deeply from the tip to the scrotum” (p. 73) • Participants viewed the film in one of 4 ways (no narrator, narrator emphasizes pain, narrator denies pain, narrator describes in detached scientific tone) • Stress: trauma narration > no narration > denial, scientific narration • Results show that people can experience stress vicariously, and that reactions depend on the process of primary appraisal.

20. Measurement of Stress • Physiological • Blood concentration of catecholamines (adrenaline, NA) and cortisol • Blood pressure, pulse rate, breathing rate, galvanic skin response. • Problems… • Taking blood may be a stressor itself • Reactive to factors other than stress • Gender, body weight, caffeine, activity level • Costly

21. Measurement of Stress • Self-report • Life Event Scales • List of potentially stressful ‘major’ events • Ss indicate which they’ve experienced during xx • Events are weighted to reflect stressfulness • Daily Hassle Scales • Considers individual values/meaning of events • Problems - reliable recall of events

22. 43 Minor violations of the law 11

23. How have you been lately? For each question, estimate how often it occurred during the past month (p. 93) 0 = never 1 = rarely 2 = occasionally 3 = often 4 = very often 5 = extremely often

24. How have you been lately? For each question, estimate how often it occurred during the past month (Sarafino, p. 93) 1 = somewhat often 2 = moderately often 3 = extremely often

26. Gender Differences in Response Women • Report greater number of major and minor stresses Men • Greater reactivity when stressed • Find different things stressful (competence challenged) • Longer to return to baseline

27. Stress and Mental Health Detrimental effects of too much stress… Single episode of extreme stress: Post-traumatic stress disorder (PTSD) • Re-experience a traumatic event • Avoid associated stimulus • Persistent anxiety/arousal Chronic/prolonged stress: • Psychological difficulties = insomnia, sexual difficulties, problems concentrating, unhappiness, alcohol and drug use • Psychological disorders = depression, anxiety, schizophrenia • burnout • response to treatment

28. Stress and Physical Health Selye’s 3-Stage General Adaptation Syndrome

29. Theory of Stress and Illness Selye’s General Adaptation Syndrome • Physiological • Alarm - body mobilized to resist the stressor (“fight or flight”) • Stage of Resistance - body tries to adapt to the stressor (body getting tired) • Stage of Exhaustion - weakened immune system, depleted energy reserves - damage and disease to body (body loses the fight against stressor)

30. Stress and Physical Health What are the effects of stress on physical health? (pp. 118-131) Acute illnesses •  colds, flu Psychophysiological disorders • Physical symptoms from psychosocial processes (psychosomatic) •  digestive system illnesses (ulcers, inflammatory bowel disease), asthma, recurrent headache Chronic illness •  cancer, hypertension, coronary heart disease (CHD) Death (?) … see case study on page 120 of your text!

31. Stress and Physical Health Ulcers - A break in the skin or mucosa caused by the loss of dead tissue. Common belief that stress is major cause of gastric or peptic ulcers. However, 90-100% with duodenal ulcers have a helicobacter pylori infection (i.e., bacterial infection) Eradicating helicobacter - recurrence rate of 4% compared to 80% in those whose ulcers heal but infection persists Helicobacter infection alone does not explain ulcers - also depends on acid secretion which appears related to stress. Anda et al (1992) - longitudinal study - those who reported high levels of stress slightly more likely to develop ulcers (7%) than those with low stress levels (4%) … stress may be related to relapse. What are the effects of stress on physical health? (pp. 118-131) Acute illnesses •  colds, flu Psychophysiological disorders • Physical symptoms from psychosocial processes (psychosomatic) •  digestive system illnesses (ulcers, inflammatory bowel disease), asthma, recurrent headache Chronic illness •  cancer, hypertension, coronary heart disease (CHD) Death (?) … see case study on page 120 of your text!

32. Suspected Stress-Related Diseases

33. Stress and Physical Health How does stress affect physical health? Direct Effects • Stress can cause changes in the body’s physiology • Cardiovascular system ( blood pressure) • Endocrine system (Catecholamine and Corticosteroid release) • Immune system (immunosupression) Indirect Effects • Stress can affect behavior; behavior can affect health • stress related to  car accidents; car accidents related to health • stress related to  coffee, alcohol, cigarettes; use related to health

34. Immune System Antigens (e.g., bacteria, virus, fungi) compete with cells for nutrients, destroy cells, disrupt metabolic processes Immune system defends the body against antigens. White blood cells (produced in bone marrow) • Phagocytes engulf and ingest antigens • lymphocytes (Killer T) destroy cells already invaded by antigens Stress lowers the concentration and activity of Killer T cells (p. 62) • More susceptible to disease when under chronic stress [Antigen = anything that triggers an immune response (e.g., donor organ)]

35. Moderators of the Stress-Illness Relationship • What is a moderator?

36. Moderators of the Stress-Illness Relationship Diathesis-Stress Model • Diathesis = vulnerability (genetic, psychological, social) • Stress = traumatic experience (environmental) Vulnerability (diathesis) + Stressor  Illness (poor social support is an example of a diathesis)

37. Moderators of the Stress-Illness Relationship • Nature of the stressor • Unpredictability, uncontrollablity, severity, duration • Personal characteristics and resources • Personality (e.g., the hardy personality) • Coping skills • External Resources • Social support

38. Moderators of the Stress-Illness Relationship • Hardy Personality (Kobasa, 1977) Control = belief in one’s ability to influence events Commitment = an approach to life marked by curiosity and a sense of meaning Challenge = a belief that change is normal and stimulating (also conscientiousness and optimism)

39. Moderators of the Stress-Illness Relationship • Coping Style • Cognitive and behavioral efforts to manage specific demands (see Sarafino, p. 134) • Problem-focused coping = controlling the emotional response to the stressor (e.g., drinking alcohol) • Emotion-focused coping = reducing the situation’s demands or gaining new resources (e.g., information seeking, breaking aversive relationships)

40. Moderators of the Stress-Illness Relationship • Assessing Coping Style (Sarafino, p. 135) • Tried to see a positive side • Tried to step back from the situation and be more objective • Prayed for guidance and strength • Took it out on other people when I felt angry or depressed • Got busy with other things to keep my mind off the problem • Decided not to worry about it because I decided everything would work out fine • Took things one step at a time • Read relevant material for solutions and considered several alternatives • Drew on my knowledge because I had a similar experience before • Talked to a friend or relative to get advice on handling the problem • Talked with a professional person (doctor, clergy, lawyer, teacher, counselor) about ways to improve the situation • Took some action to improve the situation

41. Moderators of the Stress-Illness Relationship • Social Support • aid and encouragement people receive from their interactions with others (functional social support) • Instrumental support (money, labor, time) • Informational support (advice, suggestions, info) • Appraisal support (affirmation, social comparison) • Emotional support (affection, concern, listening) • Pets (?) • Social support appears able to reduce the impact of a stressor.

42. Moderators of the Stress-Illness Relationship • Social support and dying! (p. 102) 40% 60-69 yrs 20% 50-59 yrs 30-49 yrs low medium high

43. Moderators of the Stress-Illness Relationship • Two ways social support may benefit health Low support Low support High support Health Health High support low high low high Stressor intensity Stressor intensity

44. Stress and Illness Summary and Conclusions • The relationship between stress and illness is a modest one, but stress can contribute to some illnesses • The effects of stress are dependent on a number of other, moderating factors • The fact that stress only explains a modest amount (10%) of the variance in health change does not mean that it is trivial (health is complex, multiple causes) • “evidence is less clear and fully spelled out than is generally realized” (Lazarus)

45. Stress Management • Medication • Benzodiazepines (valium), Beta-blockers (Inderal) • Cognitive restructuring • Turning a threat into a challenge • Humor • Release built-up emotion, reappraise • Relaxation • Reduce heightened arousal • Minimize physiological vulnerability • i.e., preventative (healthy behavior) …. Exercise!